Revenue Cycle Quality Program Specialist

3 weeks ago

Greenville, South Carolina, United States ECU Health Full time
ECU Health

About ECU Health


ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties.

The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.


The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children's Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University.

ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Position Summary


Under the general supervision of the Revenue Cycle, Vice President (RVP), the Quality Program Specialist is responsible for the management of key projects and initiatives within the revenue cycle department.

This includes management of activities and monitoring processes to ensure adherence to best practices and regulatory requirements. Focuses on ensuring the efficiency, accuracy, and compliance of the revenue cycle processes within a healthcare organization. Collaborate with cross-functional teams to implement strategies for enhancing efficiency, reducing errors, and optimizing revenue capture.

Responsibilities

Independence and Leadership skill

Encourage staff participation in quality improvement initiatives, solicit feedback, and recognize achievements in quality assurance and performance excellence.


Demonstrates ability to work independently in supporting the Revenue Cycle VP in implementing all aspects of our revenue cycle strategy.

Takes responsibility to make things happen and get things done for successful project delivery.

Develop, implement, and oversee quality assurance programs and initiatives within the revenue cycle department. This includes establishing quality benchmarks, performance metrics, and monitoring processes to ensure adherence to best practices and regulatory requirements.

Embraces, promotes and leads change and innovation by example.


Identify areas for process improvement within the revenue cycle, including billing, coding, claims processing, payment posting, and accounts receivable management.


Conduct regular audits and reviews of revenue cycle processes, documentation, and data to assess accuracy, completeness, and compliance with industry standards and regulatory guidelines.

Develop audit protocols, perform audits, and provide recommendations for corrective action or improvement.


Generate reports, dashboards, and presentations to communicate findings, track key performance indicators (KPIs), and measure the effectiveness of quality improvement initiatives.


Collaborate with internal stakeholders, including revenue cycle managers, billing specialists, coders, clinicians, and IT staff, to coordinate quality assurance efforts and address issues proactively.

Communicate findings, recommendations, and updates to stakeholders through regular meetings, presentations, and written reports.

Ensure that documentation is accurate, up-to-date, and accessible for internal review, external audits, and regulatory compliance purposes.
Stay abreast of changes in healthcare regulations, reimbursement policies, coding guidelines, and industry standards related to revenue cycle management.

Monitor vendor performance, contract compliance, and service level agreements to ensure value and effectiveness.


Conduct measurable and perceptible analyses using information collected through data collection, interviews, facilitated focus groups, workshops, observations, process mapping, etc.

Considers all possible alternatives to resolve operational problems as well as organizational change impact.

Recognizes sources of available information, obtains, and documents detailed facts using advanced techniques.

Uses subject matter expertise to determine optimal solution and implements plans that resolve complex problems.

Communication Skills

Demonstrates attentive and active listening.

Collaborate with operational leadership to review identified opportunities and outline requirements for implementation.

Communicate with project sponsors to keep them informed of project progress.

Demonstrates ability to produce excellent written and verbal communications for all audiences and scenarios. Matches communication style to the message and the audience.

Develops written material to support large-scale initiatives or projects. Ensure flow of bi-directional communication.

Leverages technology to aid in communication and support of audience to access information readily.

Teamwork

Develops effective working relationships with others.

Develops shared vision, goals, objectives and values and gains understanding and support from team.

Promotes cooperation and commitment within the team by working collaboratively with others and providing opportunities for involvement of team. Communicates strengths, shares expertise, draws upon other members' skills to improve team performance.

Facilitates decision making while developing team's confidence and ability to make effective decisions. Respects and reinforces team decisions once concluded.
Acknowledges and celebrates the achievements of teammates. Ensures achievements are visible, communicated and recognized across team and department.

Acts as a direct resource

Provide support and guidance to other business team members, where appropriate.

Knowledge, Skills, and Abilities Time management skills.

Ability to manage multiple projects and priorities at once.

The position is a trusted and highly skilled partner to the RVP that must model integrity and maintain confidentiality.

The role requires a high-motivated individual that demonstrates strong emotional intelligence.

Minimum Requirements

Bachelor's degree and/or 5 to 7 years direct healthcare project management experience required.

Master's degree or higher a plus.

Knowledge of healthcare practices and culture required. Must have excellent written and verbal communication skills.

General Statement


It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.


Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer.

Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law.

We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

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